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Wearable wellness

JULY 2017

Featured content

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Checking reliability, benefits of fitness trackers

On the moveLow-impact

exercises that get blood pumping

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Marijuana and your heart

Why lighting up is not a good idea

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Sleep benefitsHit the hay or your

heart may payPage 7

HIV & heart disease

Latest threat to those with virus

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NSAID risksWhat to know about

these pain pillsPage 12

Treat with a boost

Chocolate may do more than taste yummy

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By Samantha Lande

Fitness trackers have many of us covered, but are they making us healthier?

This wearable technology — in-cluding Fitbit, Garmin Vivosmart and the Apple Watch — mon-itors physical activity and some of the gadgets also measure heart rate and other vitals such as sleep. In theory, these trackers encour-age wearers to increase physical activity, which could reduce one of the most common risk factors for heart attack and stroke: inactivity. But how much of a boost are

these devices giving people? Wellness trackers “tend to nudge

some people into doing more,” said Dr. Edward Winslow, a car-diologist and associate professor of clinical medicine at Northwest-ern University. “If your goal is 10,000 steps and you are at 9,500, you’ll walk around the house just

to make it. It feeds into a competitive nature for many

people, but there is a large drop-off in people who use it.” Often, people will be excited

about their new purchase and use it religiously for a few weeks, but then lose interest in it and stop wearing it. Their interest in mov-ing more may also wane. Getting into a routine and stick-

ing to it is vital, experts say. The American Heart Association,

Centers for Disease Control and Prevention and the Mayo Clinic recommend at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise to improve cardiovascu-lar health and help combat both stroke and heart disease. Those organizations also recommend muscle-strengthening exercises at least two days per week. Intensity of exercise also may

be important. Dr. Chip Lavie, the medical director of cardiac reha-

Just breatheThe benefits of a yoga practice

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The Heart MonitorTM newsletter is a monthly publication of Tribune Online Content, publisher of the Los Angeles Times, Chicago Tribune, Baltimore Sun, Orlando Sentinel and other major U.S. newspapers. It is published at a charge of $49 per year. Note: This newsletter is not intended to provide medical

advice, treatment or instruction and is not intended to supplant any advice from your doctor or health professional. Any action you take based on information addressed in the newsletters is done at your own risk and expense. © 2017 Tribune Interactive, LLC. All rights reserved.

bilitation and preventive cardiology at the John Ochsner Heart and Vascular Institute in New Orleans, interpreted the potential clinical benefits of a Norwegian study by exercise scientist Ulrik Wisloff focusing on the Mio Slice and its personal activity intel-ligence technology. This particular technology gives a personalized score based on heart rate rather than num-ber of steps. Lavie’s study, which appeared in the

American Journal of Medicine, con-cluded that all exercise wasn’t created equal and patients need to raise their heart rate during exercise in order to lower mortality. The accuracy of the fitness trackers

also has been studied. A study led by researchers at

Stanford University and published in the Journal of Personalized Medicine compared seven devices (Apple Watch, Basis Peak, Fitbit Surge, Microsoft Band, Mio Alpha 2, PulseOn and Samsung Gear S2) on the heart monitors’ accuracy and the energy expenditure number (i.e. calories burned). The results were fa-vorable for the accuracy of the heart monitors (within the error rate of 5 percent), but the energy expenditure number was wildly inaccurate (20 percent plus) for both high and low impact activity. Another study, featured in the

Annals of Internal Medicine and conducted by researchers at Universi-ty of Wisconsin-Madison and Loras College in Dubuque, Iowa, tested four devices (Fitbit Surge, Fitbit Charge, MioFuse and Basis Peak) and found the heart rate monitor to

be “relatively poor” when compared to a concurrent reading of an elec-trocardiograph. The studies show inconsistencies in the devices — too much for many doctors to rely upon at this point.“There’s not enough research right

now for full adoption,” said Dr. Nieca Goldberg, a cardiologist and the medical director for the Joan A. Tisch Center for Women’s Health at NYU Langone Medical Center. “We, as doctors, need to figure out the best way to use these in our practice, do more research and, if useful, roll it out in an organized way.” To really measure success, physi-

cians helping patients understand the data from these devices is vital.“The most common recommenda-

tion we make (to a patient) is writing a prescription — how often and how long you should take some-thing,” Goldberg said. “When you counsel patients on exercise, you aren’t always specific. If we help patients set goals, these devices can

serve as a tool to help them follow the instructions.” And give physi-cians valuable information.Lavie agrees. “Unfortunately, many

physicians, even cardiologists, have not been asking patients about their exercise, not documenting this in the medical record, and not prescribing exercise routinely,” he said. “This is being emphasized through many educational programs, and as clini-cians and health plans recognize the critical need to implement this, these wearable devices will be increasingly recommended.” Many cardiologists remain hopeful

yet realistic about the adoption of these devices. As overall wellness and an understanding of personal health data becomes more import-ant, devices like these have the po-tential to become a key component in managing activity. It’s certainly not one size fits all, but making a differ-ence in even a subset of a popula-tion could have good results in the prevention of heart disease.

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Carson, a certified yoga instructor, health educator at Oregon Health & Science University and the co-au-thor with Carol Krucoff of “Relax Into Yoga for Seniors: A Six-Week Program for Strength, Balance, Flex-ibility and Pain Relief.” “In a lot of ways that allows us as we age to be present in our bodies and to learn to do yoga in a non-reactive way.”Carson teaches mindful yoga,

which has similar movements and postures as Hatha yoga, but empha-sizes a deeper level of awareness. Mindful yoga instructs practitioners to be more aware of how they’re engaging with different parts of their anatomy, balance, weight dis-tribution and more. So, as the name says, you’re being more mindful to how your body moves and operates in relation to emotions and thoughts. “The mindful yoga practice gives

the physical body a chance of moving into deeper states of quiet,” Carson said, “but also recognizes those patterns that can be toxic to cardiovascular disease.”Carson added that when working

with people who have cardiovas-cular disease or have had a heart attack, they’re careful when doing inversions or any position that puts the head below the heart for more than a breath or two. She advised that people ease into a yoga practice if they’ve had a heart attack, just as they would with cardiac rehab.One way to accomplish easing in is

to seek out a registered yoga teacher who leads chair yoga classes. Andrew Lee, a New Jersey-based yoga teach-er, works with many people over 50, especially those who have various medical issues, including arthritis, fibromyalgia and, yes, cardiac-related

By Ari Bendersky

The words “yoga practice” may conjure images of lithe women in their 20s carrying ergonomic mats

and insulated water bottles — and of course everything gets posted to social media.If you’re over 50, you may feel like

you don’t match the yoga lifestyle, but the truth is, yoga truly is for anyone at every age. In fact, incor-porating yoga into your daily routine has health benefits, possibly even for your heart. “One of the real advantages of a

yoga practice when it’s tailored to the older population is you get the benefits of fitness potential (i.e. strength building, balance), but it also has the contemplative and medi-tative component,” said Kimberly

Strike a poseYoga can have heart benefits

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who may have diabetes or type-2 diabetes, which makes sense because the more you move your muscles the more you’ll improve how your muscles use sugar.”

Regardless of what the studies show, yoga does help calm the mind, which is a big factor in helping relieve stress. That, in and of itself, can help reduce blood pressure. Meditation is a big part of a yoga practice and 50 percent of people who have a heart attack experience depression afterward, Zentner said. It also helps create balance within your body.

“The word yoga means union and that means looking at the balance between the yin and the yang — in yoga it’s called rajasic and tamasic energy,” said M. Mala Cunningham, the founder and director of the Cardiac Yoga Program, based in Charlottesville, Va. “Yoga is a union between these two forces to bring the system back into harmony to create a perfect balance. No matter what model of yoga you practice, people can begin to understand the health benefits.”If you do want to start a yoga

practice, especially if you’ve had a heart attack or have cardiovascular disease, you should always consult your medical professional to ensure you’re in good enough health to do yoga. And like any exercise, do what feels right to you.“Listen to your body,” Zentner

said. “It’s OK to hurt a little, but don’t push it. The beauty of yoga is it’s not a competitive sport. It’s about listening to what you can do.”

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The word yoga means union and that means looking at the balance

between the yin and the yang – in yoga it’s called rajasic

and tamasic energy.”

“

problems. As the name suggests, chair yoga

utilizes chairs — either sitting on or standing behind for support — to help people perform easy yoga poses. Participants can do various poses like seated cat/cow, extended side angle, Warrior I, Tree, spinal twist and others to stretch and in turn increase circulation, detoxify the body, enhance coordination, improve balance and help strengthen and tone muscles, Lee said. “I teach seniors chair yoga and it’s

beneficial for heart health because it can help people calm down if they’re feeling stress, especially during meditation,” Lee said. “When you’re relaxed and the body is relaxed, the mind is relaxed.”A 2014 systemic review and ran-

dom effects meta-analysis of ran-domized controlled trials published in the European Journal of Pre-ventive Cardiology suggested that yoga may help produce changes in cardiovascular disease. When com-pared with non-active controls, yoga showed “significant improvement” for systolic blood pressure and LDL and HDL cholesterol, and “signifi-cant changes” in body weight, dia-stolic blood pressure, total cholester-ol, triglycerides and heart rate. That said, it also concluded that yoga had no difference over other exercise. “There is data, although not great,

that yoga improves stress relief, cognitive function, overall mobility and strength training,” said Dr. Ali Zentner, the medical director of the group of Live Well Exercise Clinics in the Vancouver area. “So maybe there are risk factors, like lowering blood pressure, that yoga benefits. There is data that suggests yoga im-proves insulin resistance in patients

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offsetting obesity, which also contrib-utes to heart disease.”But for folks dealing with creaky

knees, sore backs and atrophied muscles, all possible results of aging, a sprint on the treadmill or a heart-pumping round of tennis may not be in order.The good news? “Any activity is

better than being a couch potato,” Shin said. “Any activity that keeps people moving and gets their heart rate up is good.”Exercise doesn’t require a break

in your routine. Thirty minutes of walking, for example, could be bro-ken up into three 10-minute periods during the workday. If you have a gym membership, but find exercise machines monotonous, break up your session between the elliptical and another low-impact, full-body machine like the rower.

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“To gain maximum heart-health benefits, do whole body movements that will increase blood flow,” said Los Angeles-based trainer Abby Lauren. “Movements such as simply walking at a brisk pace or walking up stairs using your arms are great examples. Using the whole body by keeping all extremities moving will increase the heart rate faster and more efficiently.”To avoid injury and get the most of

your sweat sessions, Lauren recom-mended adhering to the following tips for these low-impact exercises.

Biking/spinningFirst, focus on your position in the

seat, or saddle. “When seated, your knee should be directly over your toe,” Lauren said, and “your knees and elbows should have a slight bend.” Keep your core engaged to protect your back and press your shoulders down and back away from your neck. When pedaling, keep your heels down so your weight is distrib-uted evenly, and resist the urge to tuck your head as this puts a strain on the cervical spine, she said.

RowingYou may be tempted to lead your

motion by pulling the yoke back with your arms and upper body. This is wrong, Lauren said. “Rowing is mostly legs,” she added, “using mainly hamstrings. The rest is core and arm strength.” On the rowing machine, “always push with the legs first, engaging the hamstrings and gluteus muscles in the back of your legs. Once you get back, pivot your shoulders so they are behind your hips, then use your core and shoulders to pull the bar toward you. Always keep core engaged to avoid hunching the back.”

Speed walkingTo get the most from speed walk-

ing, proper form is key. “Notice your

By Lucy Maher

If you’re trying to fit into that suddenly snug pair of jeans or hoping to run after your grandkids during this summer’s

family vacation, you know that exer-cise is key to whittling your waistline and boosting energy.It’s also essential in the manage-

ment of heart disease, which each year kills 610,000 of the 28 million people diagnosed with it. To put that into perspective, that’s 11.7 percent of the adult population.“High blood pressure and high

cholesterol are two major risk factors that contribute to development of heart disease,” said Dr. Victoria Shin, a cardiologist with Torrance Memori-al Medical Center in Torrance, Calif. “Exercise has its role in heart health by helping to lower both, as well as

Go low for good healthWalking, biking, rowing offer great benefits

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stride and how your toes point,” Lauren said. “If they point in or outward, concentrate on aligning them forward.” What’s more, “you can walk as far as you want and as fast as you want, but if you are not engaging the core and focusing on using the muscles in the back of the leg and front, it will not be as ben-eficial.” With each stride, keep your chin up, shoulders down and back, and always keep your core engaged.Other easy-on-the-joints exercises

include moderate incline hiking and even dancing, Shin said. She recom-mended swimming or aqua aerobics for those with arthritis and musculo-skeletal problems. “For people who would benefit

from lowering their blood pressure or cholesterol,” she said, “we recom-mend 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week to lower the risk for heart attack and stroke.”

Tip of the month

Walking every day is good

for your overall health.

It allows you to get fresh air, gets

your blood pumping and gets you

out of your chair and stretching

your legs. If you use some sort

of wearable technology like a

Fitbit or Mio or carry a smart

phone in your pocket that has

a built-in pedometer, you know

tracking your steps can become a

bit of a game. If you find yourself

hovering around 9,000 steps for

the day, get back outside. Take

the dog for a walk or go up and

down the stairs a few times. Push

yourself over 10,000 steps, which

many experts recommend for

good health.

By Ed Avis

As marijuana legalization slowly spreads across the United States, more recreational users rejoice

in the freedom to enjoy a few puffs of weed. But while getting high may relax you, it’s not relaxing to your heart. Despite not having enough conclusive research, smoking weed could, in fact, also be dangerous to your heart. “The data we have is mostly from

case studies, retrospective studies

The marijuana questionLighting up carries risks

and observational studies, which is the lowest level quality of data,” said Dr. Micah Eimer, a cardiologist and the medical director of the North-western Medicine Glenview Outpa-tient Center in Glenview, Ill. “Never-theless, all of us seem to agree there is some association of marijuana use with heart attack, possibly stroke and heart failure.”One consequence of marijuana

usage that seems indisputable is increased heart rate.“Marijuana relaxes most people,

so many believe it drops their heart rate, but it doesn’t,” said Dr. Harold Urschel, chief medical strategist for Enterhealth, an addiction treatment center in Dallas. “It actually raises an individual’s heart rate between 20 and 100 percent depending on the potency of the marijuana.”

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By Kathleen Furore

There is, it appears, at least some truth to the Irish proverb, “A good laugh and a long sleep are the

best cures in the doctor’s book” — at least where sleep is concerned. The amount of sleep you get, or don’t for that matter, can affect heart health.“Large studies have shown that

decreased sleep leads to a higher percentage of people developing hypertension, MI (myocardial in-farction) or stroke,” said Dr. Aidan R. Raney, the director of Structural

Heart Disease at St. Joseph Hospital in Orange, Calif. “It is pretty much accepted that lack of sleep doesn’t lead to healthy outcomes.” So how much sleep should we get?

Adults should regularly sleep seven or more hours per night to promote optimal health, according to the American Academy of Sleep Med-icine and the Sleep Research Soci-ety. The two organizations jointly concluded that sleeping less than that on a regular basis could lead to adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression and increased risk of death.According to sleep experts, fre-

quently waking throughout the night is not necessarily a reason to panic.“Sleep is not anesthesia,” said Dr.

That jump in heart rate, which lasts at least an hour after consumption, can trigger a heart attack. A study at Beth Israel Deaconess Medical Cen-ter in Boston in 2000 determined the risk of heart attack jumps 4.8 times in that first hour. To put that into perspective, the study noted that marijuana usage is less dangerous than a spurt of exercise for someone who doesn’t normally exercise, but is more dangerous than sex for a sedentary person.More recently, a French study in

2014 found that nearly two percent of all health complications related to marijuana use that were reported to the French Addictovigilance Net-work were cardiovascular problems. Of the 35 pot-related cardiovascular problems reported to the network from 2006 to 2010, 20 were heart attacks.Marijuana may affect heart health

in other ways, too, but the data is in-

conclusive. Eimer noted that tetrahy-drocannabinol, the chemical respon-sible for marijuana’s high, seems to trigger effects that can both worsen heart disease and help it. The net effect is simply not yet known.Smoking marijuana has the added

negative effect on your health from the smoke itself, especially since users typically inhale deeply. A study reported in the New England Jour-nal of Medicine in 1988 concluded that smoking marijuana results in five times as much carbon monox-ide in the blood and three times as much tar in the lungs as smoking the same amount of tobacco from a filter-tipped cigarette.But if you’re not smoking your pot,

is it healthier? Insofar as avoiding the smoke, yes, edibles are better for you. But the other effects are still there.“There have been cases of edibles

causing heart attack,” Eimer said.The data implicating marijuana use

in heart problems seems fairly clear, but it’s not definitive. Eimer points out other factors may confound the studies, such as use of other drugs, obesity, socioeconomic factors and more. And some data shows that mari-

juana may have anti-inflammatory properties, which could help your heart. Zvi Loewy, the chairman of pharmaceutical and biomedical sci-ences at Touro College of Pharmacy in New York, said his lab has iden-tified anti-inflammatory properties in marijuana such as a reduction of vasoconstriction and prevention of excessive cell apoptosis (cell death).“The lab is now involved in purifi-

cation of anti-inflammatory actives from marijuana extracts,” Loewy said.However, despite these shreds

of hope, the safest use of weed is probably no use. To drive that point home, Eimer warned: “Stay away from it.”

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Get your ZZZ’s to protect your beats

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Continued from Pg. 7Andrew Varga, assistant professor of medicine, pulmonary, critical care and sleep medicine at the Icahn School of Medicine at Mount Sinai Health System in New York. “It is normal for some kind of awakening, but it is also normal to fall back to sleep.”Waking up and remaining awake

for more than 15 to 20 minutes at a time, however, can be cause for alarm. “Frequently awakening is not necessarily a sign of an exist-ing problem, but it can predispose you to adverse cardiac events,” he explained.Frequent wakening, for example,

can signal problems such as obstruc-tive sleep apnea, a common sleep disorder (often triggered by obesity) that causes the upper airway to be blocked during sleep; breathing usu-ally resumes with a loud gasp, snort

or body jerk.“OSA has been very well docu-

mented to increase bad cardiovascu-lar outcomes,” Raney said. “It is well correlated with hypertension and (other) changes in the body. This leads to increased risk of stroke, heart failure and coronary disease.”If you have trouble sleeping, try

following these tips to get a healthier dose of nightly shut-eye: Be consistent: Limiting variation

in the time you go to bed and wake up can be an antidote to sleep issues, Varga said. “Try to minimize any difference between your week and weekend routines,” he added.Wind down: Allow at lease 30 —

preferably 60 — minutes of what Varga called “electronic device free-dom” before bed. A backlit screen, with its blue spectrum wavelength, stimulates cells behind the eyes, which in turn signal the hypothal-amus to wake up. “The brain is getting mixed signals,” he said. Avoid stimulation: People with

sleep problems should avoid TV, caffeine, nicotine and alcohol before bedtime, Raney said. Get help: “If you think you have a

problem sleep disorder like insomnia or sleep apnea, it really should be ad-dressed — so see a sleep physician,” Varga concluded.

Frequently awakening is not necessarily a sign of an existing problem,

but it can predispose you to adverse cardiac events.”

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Recipe Rescue Indian Curry

use the freshest available. Curry is a complex mixture of herbs and spic-es, most often including coriander, cumin and turmeric, as well as fresh or dried chiles. If you shy away from curry because of its implied heat level, rest assured this one is flavorful but mild.Serving tip: Serving basmati rice

would be typical with this type of entree, but whole-grain brown rice adds more fiber.

Indian inspired slow cooker chickenMakes 6 servings

Nonstick cooking spray• 1 medium yellow onion, diced• 1 teaspoon dry minced garlic• 2 tablespoons brown sugar• 2 teaspoons chili powder• 1 teaspoon ground coriander• 1 teaspoon turmeric• 1 teaspoon ground cumin• 1/2 teaspoon ground cinnamon

Indian curries made with ghee (clarified butter), coconut milk or cream are seductively rich and undeni-

ably delicious — but they’re often high in saturated fat, calories and sodium.The American Heart Associ-

ation advises to choose curries with a vegetable or dal (a pulse of dried lentils, peas and beans) base instead. The health organization also advises choosing chicken or seafood over beef or lamb.The Kansas City Star’s Indi-

an-Inspired Slow Cooker Chick-en uses reduced-sodium broth, no-salt-added tomatoes and with fat-free or light sour cream for a touch of richness.Curry may rhyme with “hurry,”

but curries actually lend them-selves to preparation in the slow cooker.Preparation tip: Spices are crit-

ical to this dish. It’s important to

• 1/2 teaspoon salt• 1/4 teaspoon coarse

ground black pepper• 1 (14.5-ounce) can no-salt-

added diced tomatoes, with liquid• 1 cup reduced-sodium

chicken broth• 1 1/2 pounds boneless,

skinless chicken breast or boneless chicken thighs• 1 cup fat-free or light

sour cream• 3 tablespoons chopped

fresh cilantro• 11/2 cups cooked basmati

or brown rice

Spray the interior of a 4-quart slow cooker with nonstick cook-ing spray.Place onion, garlic, brown sugar,

chili powder, coriander, turmeric, cumin, cinnamon, salt, pepper, diced tomatoes and chicken broth in the crock. Stir to combine well. Submerge chicken pieces into sauce until covered. Cover slow cooker and cook on low for about 4 hours or until a meat thermom-eter registers 165 degrees.Stir in sour cream until blended

and heat for about 10 minutes to heat through. Sprinkle with cilan-tro. Serve over cooked rice.Per serving (based on bone-

less breasts, fat-free sour cream, basmati rice): 250 calories (9 percent from fat), 3 g total fat (1 g saturated), 70 mg cholesterol, 25 g carbohydrates, 33 g protein, 307 mg sodium, 2 g dietary fiber.

—Recipe developed for The Kansas City Star by professional home economists Kathy Moore

and Roxanne Wyss.

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By Meredith CohnTribune News Service/ The Baltimore Sun

People infected with HIV can now live long, healthy lives — so long as they don’t have a heart attack.

Cardiovascular problems among HIV patients are emerging as the latest threat they face and a major challenge for medical experts, whose success using antiretroviral drugs to prolong patients’ lives has given rise to new risks.“When I first started taking care of

patients in the 1980s they virtually would all die, but now they’re living and getting complications from the disease, the most prominent of which is cardiovascular disease," said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.Fauci said the search is on for a

consistent method to stave off heart attacks and strokes in those with

HIV. A promising avenue may be adding a daily lipid-lowering drug to the mix, even in patients without the usual signs of trouble such as high cholesterol or high blood pressure.To test the idea, the National Insti-

tutes of Health has lined up about 100 hospitals, academic centers and health facilities around the globe — including the University of Maryland and Johns Hopkins Medicine in Bal-timore — to take part in a long-term study that will provide a drug known as pitavastatin to HIV patients with-out signs of cardiovascular disease to see if it prevents heart problems.Pitavastatin is used routinely in

heart patients to lower cholesterol and has proven safe to take with HIV medications. Doctors such as Fauci already had been giving it to their healthy HIV patients assum-ing it would help them not only by keeping high cholesterol at bay but by also lowering HIV-associated inflammation that can cause plaque

buildup in the blood vessels.However, there is no solid scientific

evidence the statin works in healthy HIV patients, Fauci said.The REPRIEVE trial, which stands

for Randomized Trial to Prevent Vascular Events in HIV, will fol-low patients for an average of four years each. They will come in a few times a year for tests at participating facilities.Hopkins hopes to recruit 75 to 100

people, and already has about three dozen in the NIH trial, one of many on HIV/AIDS by researchers there, said Jamilla Howard, a research nurse for the AIDS Clinical Trials Group and the HIV Prevention Trials Network at Hopkins. The pa-tients will come from various health facilities in the region and get extra screening for heart disease.

Stacey Scott, a 45-year-old East Baltimore mother, didn't hesitate to enroll in the study when she learned about it from her Hopkins doctor, Dr. Christie Basseth, who has been caring for her for a dozen years.“I have HIV and a history of heart

disease in my family, and if they want to spend the four years making sure my heart is good, I’m all for it,” Scott said.She wouldn’t always have been in-

terested in taking another pill. Scott was devastated to learn she had the

HIV and heart attacksCardiovascular problems latest threat to those with virus

When I first started taking care of patients in the 1980s

they virtually would all die, but now they’re living and getting

complications from the disease, the most prominent of which is

cardiovascular disease.”

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virus in 1994 but quickly abandoned her regimen HIV medications be-cause they made her feel sick.The virus soon took its toll; she

developed full-blown AIDS. Con-sidering the effect on her young son if she died and learning about a new generation of medications moved her to “straighten up.”She now religiously takes an an-

tiretroviral drug and a study pill each morning. And though it’s not always comfortable for her, she forces her-self to speak to the young women in her neighborhood about the dangers of drug use and promiscuity. There were 39,513 new diagnoses

nationally in 2015, according to the U.S. Centers for Disease Control and Prevention. There are about 1.2 mil-lion people living with HIV across the country, though 1 in 8 don't know they have the virus. Experts say the untreated HIV not only caus-es harm to those infected but also allows the virus to be easily spread.About 6,700 people die from HIV

Continued from Pg. 10harming the body’s vessels.“There seems to be an accelerat-

ed risk of developing plaque in the arteries including heart arteries,” Feinstein said. “It leads to an earlier manifestation of heart disease.”Cholesterol drugs reduce cholester-

ol and inflammation to some extent, said Feinstein, though the degree to which it does has been debated. He said some of his other research has shown that taking a statin can lower risk when the risks of a heart attack are high, but not much when there are few risk factors. That is why many doctors do not offer the medications to younger, relatively healthy people.That is also why the large NIH

study will be useful, said Feinstein, who will be keeping tabs on the NIH study through Northwestern, which also is participating in the trial.So will Dr. Michael Horberg,

director of HIV/AIDS at Kaiser Permanente and past chair of the HIV Medicine Association. He does not normally offer a cholesterol drug to his HIV patients and said he has found that keeping HIV in check has helped with other HIV-related problems.“HIV treatment is prevention and

it improves quality of life,” Horberg said.But he said some patients have

other risk factors, or didn’t know they were infected with HIV until the virus had done damage to their bodies. They might benefit more from a cholesterol drug than some-one without HIV might.Horberg said he believes the NIH

study could show some healthful ef-fects of taking a cholesterol drug. If it does, he will consider prescribing them more.

and AIDS in the United States each year, making it a top 10 killer for those age 25 to 44. Most infected people die of related problems like cancers, infections and heart attacks.Previous research on HIV by Dr.

Matthew Feinstein, a cardiovascular disease fellow at Northwestern Uni-versity Feinberg School of Medi-cine, showed that heart disease was being vastly underestimated in HIV patients.The risk of a heart attack is one

and a half to two times higher in an HIV patient than a healthy person. Feinstein found the virus was still having this profound affect even when it was suppressed by medica-tions.The effect could not be attributed

to patients living longer and suffer-ing from the same health conditions as other Americans with poor diet and exercise habits, though aging does play a role. Feinstein said it likely has more to do with chronic inflammation spurred by HIV that is

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NSAIDs available by prescription include diclofenac sodium (Voltaren and Solaraze) and celecoxib (Cele-brex). Although aspirin is considered a type of NSAID, it doesn't appear to be associated with a higher risk of heart attack or stroke.

The risk of heart disease associated with NSAIDs is highest in people who already have a heart condition. But it can be a concern in those who don't have heart problems, too. The reason for the connection between

NSAIDs and heart disease is unclear. The risk was first uncovered in a clinical research study conducted in 2003. The study looked at NSAIDs called COX-2 inhibitors, and it found that the medications were in-creasing cardiovascular events. Some drugs were taken off the market as a result of that study.The COX-2 inhibitor that's now on

the market, celecoxib, is formulated differently than those in the 2003 study. The heart disease risk associ-ated with celecoxib is lower than the older COX-2 inhibitors, but it still exists. However, research has shown that celecoxib's heart disease risk is no higher than that of ibuprofen or naproxen. Celecoxib is most often recommended for people with rheu-matoid arthritis, osteoarthritis, men-strual cramps and injury-related pain.

Do NSAIDs raise heart disease risk?

The risk of heart disease associated with

NSAIDs is highest in people who already have

a heart condition.

Tribune News Service/ Mayo Clinic News Network

Dear Mayo Clinic: Is it true that taking prescription-strength nonsteroidal anti-in-

flammatory drugs, or NSAIDs, can increase my risk of heart disease? How much is too much, and should I be concerned about regularly tak-ing over-the-counter NSAIDs?A: Research has shown that taking NSAIDs can raise the risk of heart disease, particularly heart attacks and strokes. To keep your risk low, if you use NSAIDs, take the lowest dose possible for the shortest amount of time necessary to relieve your symptoms.NSAIDs are drugs commonly

used to treat pain and inflammation. Examples include the nonprescrip-tion medications ibuprofen (Advil and Motrin) and naproxen (Aleve).

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It's available by prescription only.Although there is a higher risk of

heart disease associated with NSAID use, that doesn't mean these medi-cations are unsafe. If you don't have a history of heart problems, it's fine to take NSAIDs occasionally in the recommended doses for short-term pain relief.NSAIDs become a more significant

concern if you regularly use them to treat chronic conditions, such as osteoarthritis or rheumatoid arthritis, over a long period of time. If you take multiple doses of NSAIDs daily for weeks at a time to combat pain due to a chronic illness, talk to your health care provider about an alter-native that may be able to keep your symptoms in check without increas-ing your heart disease risk.If you have a history of heart dis-

ease or other heart problems, talk to your health care provider before you take any NSAIDs, including those you can buy without a prescription. He or she may recommend you use another type of medication, such as acetaminophen, for pain relief that isn’t associated with an increase in heart disease risk.Whenever you visit your health care

provider, make sure he or she knows about all the medications you take regularly — both prescription and nonprescription, including NSAIDs and other over-the-counter pain relievers. If you have any concerns about your medications, your provid-er can help you review the pros and cons, and sort out what’s right for your situation.Finally, when you take NSAIDs,

read the label instructions careful-ly before you take them, and use NSAIDs only as directed. Talk to your health care provider if you have questions about NSAIDs.

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higher the dose, the lower the risk.What is this wonder drug? Choco-

late.

The researchers, led by Elizabeth Mostofsky, an epidemiologist who studies risk factors for cardiovascular disease at Boston’s Beth Israel Dea-coness Medical Center, weren’t the first to look for evidence that choco-late might prevent some cases of the dangerous heart rhythm, called atrial fibrillation.In one previous study, researchers

Chocolate contains flavanols that can prevent the kind of

inflammation that can lead to tissue damage.

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A deliciousdoseStudy finds chocolate may reduce risk of irregular heartbeat

By Karen KaplanTribune News Service/ Los Angeles Times

Medical researchers have identified a compound that may reduce your risk of a dangerous

type of heart rhythm that can lead to strokes, dementia, heart failure and early death.In a study of more than 55,000

Danish men and women who were tracked for up to 16 years, people who used this compound were up to 20 percent less likely to experience the heart condition. In general, the

were unable to find a link between chocolate consumption and self-re-ported cases of atrial fibrillation among nearly 19,000 American doctors participating in the Physi-cians’ Health Study. Another group of researchers also struck out when they examined more than 33,000 Americans who were part of the Women’s Health Study.But Motosfsky and her colleagues

had reason to believe they would find a connection. Atrial fibrillation is believed to result from the release of certain molecules that ultimately damage heart tissue. That damage changes the way electrical signals travel through the chambers of the heart, causing one’s heartbeat to flutter instead of beating in a steady rhythm.Ingredients in chocolate are known

to counteract some of these prob-lems. For instance, chocolate con-tains flavanols that can prevent the kind of inflammation that can lead

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to tissue damage. They may also counteract the clots that could form when an irregular heartbeat allows blood to pool up in the heart.So the researchers examined data

from the Danish Diet, Cancer and Health Study. Participants enrolled during the 1990s, when they were between the ages of 50 and 64. At the time, they completed detailed questionnaires on the foods they ate and how often they ate them.By December 2009, the researchers

found 3,346 clinically confirmed cas-es of atrial fibrillation, or AF, among the 55,502 people in the study. They also found a pattern to those cases.Compared with the people who ate

chocolate less than once a month, those who ate it one to three times a month were 10 percent less likely to develop AF. Study participants who ate chocolate once a week were 17 percent less likely to have AF, and those who ate it two to six times a week fared best, with a 20 percent lower risk. For daily chocolate eaters, the risk of AF was 16 percent lower than for people who indulged less than once a month.Although men were more likely

than women to develop AF, the ben-efits of chocolate were seen in both genders. Among men, the risk was lowest for those who ate chocolate two to six times per week; among

women, the risk was lowest for those who ate it just once a week.The statistical analysis controlled

for factors like blood pressure, cholesterol and body mass index that might be linked to both choc-olate-eating and AF. All of these results were statistically significant, the researchers reported.The results were published in the

journal Heart.The authors wrote that their study

may have turned out differently than the previous ones because chocolate in Denmark contains more cocoa — the suspected beneficial ingredient — than it does in the U.S. Here, milk chocolate must have at least 10 per-cent cocoa solids, and dark choco-late must have at least 35 percent. In Denmark, the requirements are 30 percent and 43 percent, respectively.Another difference is that the new

study measured cases of “clinically apparent” atrial fibrillation that were recorded in Denmark’s national health records. The American stud-ies relied on self-reports of AF.Although the study shows a clear

link between chocolate consumption and the risk of atrial fibrillation, it doesn’t prove that chocolate was responsible for the reduced AF risk. That would require a different kind of study in which volunteers are randomly assigned to eat certain amounts of chocolate, or none at all.So if you’re one of the millions of

people who has atrial fibrillation, don’t count on chocolate to resolve your medical problem.Chocolate is full of sugar, fat and

calories, Mostofsky warned in a statement. “But moderate intake of chocolate with high cocoa content may be a healthy choice,” she said.

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Recipe Rescue Pasta with Spinach, Garbanzos and Raisins

Here’s a low-sodium recipe to try tonight.

Yield: 6 servings

• 8 ounces dry bow-tie pasta• 2 tablespoons olive oil• 4 garlic cloves, crushed• 1 cup canned garbanzo beans (chickpeas), drained

and rinsed• 1/2 cup chicken or vegetable

broth• 1/2 cup golden raisins• 4 cups fresh spinach,

chopped

• 2 tablespoons grated Parme- san cheese• Cracked black peppercorns,

to taste

1. Fill a large pot 3/4 full with water and bring to a boil. Add the pasta and cook al dente, according to the package directions. Drain the pasta thoroughly.

2. Meanwhile, heat the olive oil and garlic in a large skillet over medium heat. Add the garbanzos and chicken or vegetable broth.

Stir until warmed through. Add the raisins and spinach. Heat just until the spinach is wilted, about 3 minutes. Do not overcook.

3. Divide the pasta among the plates. Top each serving with 1/6 of the sauce mixture, 1 teaspoon Parmesan cheese and peppercorns to taste. Serve immediately.

Per serving: 316 calories; 7 g fat; 1 g saturated fat; 16 mg choles-terol; 10 g protein; 57 g carbo-hydrate; 16 g sugar; 4 g fiber; 153 mg sodium; 72 mg calcium

To contact the Heart Monitor newsletter, please email heartmonitor@tronc.com. For subscription and customer service inquiries, call 1-844-681-6006.

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